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I'm too young to have colon cancer

Dear Alice,

I am 17 years old. I am experiencing abdominal pain and tenderness, gas and constipation, everyday, and I am lactose intolerant. I looked up the symptoms to colon cancer and I have all of them except bleeding from the stool. I'm thinking about going to the doctor but what do I say to them? I also experience a nervous stomach so I thought it might be ulcers. Can you please help me, because I think I am too young to have colon cancer?

Dear Reader,

You are right that colon cancer would be extraordinarily rare in someone your age. However, a number of other intestinal conditions are more common in people your age, including:

An infection

A food allergy or intolerance (such as celiac disease, an extreme sensitivity to wheat)

Whenever someone experiences such significant changes in her or his bowel patterns, it's worth checking in with a health care provider to make sure that there isn't a problem that needs treatment. Your health care provider will gather additional information, face to face, with questions and perhaps with tests. S/he can then narrow down your symptoms to a specific diagnosis.

If you live with your family, perhaps your pediatrician is a place to start, since s/he is trained to see people from birth until age 21. If you are away at school, the health service is another starting place. It's good to say that you have been experiencing certain symptoms, that you have had them for a specific length of time, and that you are worried it might be cancer. Say this to the person who makes the appointments over the phone, to the person who interviews you in person, and/or to your medical provider at your appointment. You can meet with the health care provider in her or his office for a discussion, fully dressed, before going into the examining room to change into a gown, which also can help you feel more comfortable.

Is there someone who could go with you to an appointment? A family member or close friend? It's sometimes useful, especially when you are anxious, to have another pair of listening ears at appointments.

When you see your health care provider, you need to express to him or her exactly how concerned you are by your symptoms. In the time leading up to your appointment, you may start keeping a journal of the things you eat and the kinds of symptoms you experience. Writing things down may reveal some pattern(s) to your discomfort, and can often assist with a diagnosis.

You may wish to ask your health care provider some of the following questions:

Do you think this might be a serious or progressive condition?

Could my symptoms be due to an infection? An allergy? A chronic bowel condition (such as irritable bowel syndrome or an inflammatory bowel disease)?

What tests can be done to reveal an infection, an allergy, or a chronic bowel condition?

Are there medications I could take to make me more comfortable?

Do I need to see a specialist in intestinal problems (i.e., a gastroenterologist)?

What kinds of symptoms would alert me to make another appointment?

Since you already know that you are lactose intolerant, have you completely eliminated all sources of lactose from your eating plan? Some mildly lactose intolerant people need to avoid all dairy products or need to use lactase supplements when consuming dairy products, but can comfortably eat the amounts of lactose that may be in food products such as bread. Other people are much more sensitive to even tiny amounts of lactose, and need to read food labels carefully for ingredients such as whey, curds, milk, and milk by-products, solids, or powders, all of which contain lactose. People who are severely lactose intolerant need to check with their pharmacist about the prescription and over-the-counter medications they use; more than 20 percent of prescription medications and about six percent of over-the-counter drugs have lactose in them, including birth control pills and medications to treat stomach acid and gas.

And, are you absolutely sure that you are lactose intolerant, and not allergic to milk protein? If you are allergic to milk protein, you need to look for even more hidden sources of this protein that may exist in foods. Look for the words casein, caseinate, whey, curds, or hydrolysates, and be aware that lactose-free dairy products (such as lactose-free milks) still contain milk protein.

You and your health care provider are partners who will work together to figure out the source(s) of your discomfort.